Thursday, June 14, 2007

BIG PROGRESS IN TREATING ARTHRITIS -- BUT CAN THE NHS AFFORD IT?

It's much more important to pay the vast army of NHS bureaucrats. The NHS has 1.3 million employees, of whom less than 70,000 are doctors. Bureaucrats don't heal the sick but the latest medications might. So what is the NHS for, exactly?

Tens of thousands of patients crippled by rheumatoid arthritis can expect dramatic improvements in their treatment with the arrival of a new class of “smart” drugs, scientists said today. A study of three medications has shown that they can reduce the symptoms of rheumatoid arthritis, the debilitating joint disease, by about 50 per cent. Experts say the drugs will help liberate many sufferers with severe disease from pain and allow them to lead a near-normal life.

However, doubts remain over patients’ chances of getting the new drugs, which have yet to be approved by the National Institute for Health and Clinical Excellence (NICE), the government watchdog, and could add around 250 million pounds a year to the NHS drugs bill. Britain lags behind other European countries and the US in introducing new medicines. Drugs launched in the past five years, including this new class, make up 27 per cent of the bill for medicines in the US, 24 per cent in Spain, 22 per cent in France, but 17 per cent in the UK.

Trials have shown that the three drugs – MabThera (rituximab), Orencia (abatacept), and tocilizumab – can have a marked impact on symptoms of rheumatoid arthritis, which include joint pain, stiffness and swelling. The disease, which occurs when the immune system attacks the joints, affects an estimated 400,000 people in the UK, 4,000 seriously. Each new drug consists of molecules that target different parts of the immune system.

MabThera and Orencia are licensed in the UK; the latter was launched this month, while tocilizumab is undergoing later-stage clinical trials. Professor Paul Emery, a leading British specialist and co-au-thor of the review in today’s online edition of The Lancet, said: “They are strikingly effective and they work on different targets from the existing drugs, that’s the joy of it .”

The research showed that all three slowed progression of the disease and reduced its symptoms. All achieved the best results when used in combination with the standard treatment, methotrexate. Not all patients respond, and there can be serious side-effects in some, but 30 to 40 per cent of patients do see big improvements. Drugs that do not work for one patient may do so for another, enabling rheumatologists to tailor the treatment to the patient.

Scientists said that the new drugs would raise the chances further of patients finding an effective treatment. “A new era has started in the treatment of rheumatoid arthritis,” Professor Josef Smolen, who led the team, said. Ailsa Bosworth, chief executive of the National Rheumatoid Arthritis Society, said: “It means that we have some choices, and that’s very important if you are 22 and facing a lifetime of the disease.” Traditional treatments include nonsteroidal antiinflammatory drugs, glucocorticoid steroids, and disease-modifying antirheumatic drugs. All have limited effectiveness, but treatment has greatly improved by the introduction of drugs that target tumour necrosis factor (TNF), a major source of the inflammation at the heart of the disease. Three antiTNF drugs are already licensed and approved by NICE for patients with severe disease.

The Lancet review focuses on the next generation of antibody medicines, which home in on targets other than TNF. MabThera targets immune system cells called B cells, which are known to be involved in the development of the disease. In trials it reduced symptoms by more that 50 per cent in more than a third of patients. Oren-cia targets immune system T cells and, when combined with methotrexate, also reduced symptoms by 50 per cent, in 40 per cent of patients. Tocilixumab targets inter-leukin-6, a cytokine (signalling compound) that activates the T-cells. It is not yet licensed but in trials has shown similar benefits to the other two drugs. With annual treatment costs per patient likely to be between 3,000 and 10,000 pounds, the cost of treating 40,000 patients (the number who have the disease sufficiently severely to get antiTNF drugs) is likely to be about 250 million.

They pose as the chummy cohorts of mums and dads. Yet family liaison officers in British schools are undermining teachers and keeping a suspicious eye on parents.

The first time I heard mention of the school family liaison officer was when, in the morning rush of dropping our children off at school, a close friend tearfully confided that she had been `asked' by the headteacher to `have a chat' with the family liaison officer. Two days later and another friend revealed exactly the same news. Who was this family liaison officer to make two of my friends, both with bright, healthy, much-loved children, somehow feel they had `failed' at being good parents?

British parents are going to have to get used to them. If your local school doesn't have a family liaison officer, it will soon. The exact job description of officers is difficult to pin down; they are often presented in recruitment adverts as neutral mediators between teachers and parents, helping families in `accessing relevant information' (1). Allison Shepherd, the family liaison officer at a school in Thanet, Kent, describes her role as being `to provide support, help, friendship and act as a link between families and school' (2). Jo Green from a primary school in Folkestone is similarly friendly: `My job is to help you. Should you be having personal problems or school related problems I am here as your listening ear.' (3)

Behind the chummy `I just want to be your friend' image, the role of the family liaison officer is to work with the parents of children considered to be at risk due to child protection concerns or at risk of social exclusion. They will work with the parents of children who truant or misbehave as well as parents with poor literacy and numeracy skills.

The aim of providing `parenting and family support' was first raised in the UK government's Green Paper, Every Child Matters, which was published in September 2003 in response to the investigation into the murder of eight-year-old Victoria Climbi, by her aunt and her aunt's boyfriend in London in 2000 (4). Every Child Matters argues for the need for `specialist parenting support', involving a range of home visiting programmes to teach parents how to best support their child's development, and parent education programmes to provide training in `behavioural techniques'.

The message to emerge from Every Child Matters is that parents need to be monitored and taught how to behave if they are not to be a potential risk to their own children. Rejecting the friendly advances and offers of support from the family liaison officer may be enough to mark your child out as being `at risk' in which case `compulsory action' could be taken in the form of Parenting Orders.

The role of the family liaison officer may be presented as a means of protecting children considered to be at risk through supporting families, but the effect of such liaison serves only to undermine families at every stage. By stressing so emphatically that families need help to carry out the everyday demands of parenting (the word `support' appears 176 times in Every Child Matters), the implication is that families do not do a good enough job when left to their own devices.

Both of my friends were asked to chat with the family liaison officer after their children got into fairly minor playground scraps. The very fact of being asked to discuss these incidents with a professional suggests, firstly, that children kicking each other in the dinner queue is something shockingly bad that requires intervention from at least five adults and, secondly, that it is something parents cannot be trusted to deal with on their own.

Presumably, within the context of much agonising as to why the child should demonstrate such behaviour, the family liaison officer will make some clich,d suggestion such as `reward their good behaviour' or `put them on the naughty step'. At issue is not the value of the advice but the fact that by not allowing parents to work out these things for themselves, their confidence is undermined and the autonomy of the family unit is called into question.

Furthermore, having family liaison officers based in schools undermines the authority of teachers in dealing with unruly pupils. In the not-too-distant past, such a trivial incident as kicking a child in the dinner queue would have been dealt with by the class teacher, if it were actually deemed worthy of being dealt with at all. Go back a couple of years further and any sensible adult would have laughed at the notion of getting involved. Parents trusted teachers to deal with such minor offences.

Parents also trusted teachers to get on with the job of educating their children. Far from family liaison officers freeing up more time for teachers to spend on education, they will require paperwork referrals to be completed and formal mediation meetings to be attended. Teachers are no longer limited to the role of educating children but are expected to extend their responsibilities to an assessment of how well the children in their class are being brought up. The purpose of the school becomes renegotiated away from the academic education of the child to the social (re)education of the whole family.

Family liaison officers suggest teachers cannot sort out minor breaches of discipline by pupils and that parents and teachers cannot communicate with each other without the need for someone else to `mediate'. Formalising relationships between parents and teachers with the presumed necessity for third party mediation does nothing at all to help protect children. Far too much time is taken up with the dinner-queue-kickers who are neither a risk to others or at risk themselves. The informal end-of-the-day conversations in the school playground, where teachers and parents can pass on any concerns to each other, suddenly take on a new complexion if the parent fears anything they say may be reported to the family liaison officer.

Let's not forget that the role of the family liaison officer originated from the police service where their aim is to mediate with families in order to better secure convictions. (5) The introduction of such policing techniques in schools heralds unprecedented interference into the autonomy of families - rather than supporting families this serves only to undermine them. Parents, when asked to meet with the family liaison officer, will only become less confident in their own ability to bring up their children as they see fit. This cannot possibly be to the benefit of the child. The best way for schools to support families is to leave them alone and concentrate on the job of educating their children.

The never-ending campaign by the Left to prevent kids acquiring any depth of knowledge (so that voters are less likely to see through their deceptive claims) is very advanced in Britain

I am a physics teacher. Or, at least I used to be. My subject is still called physics. My pupils will sit an exam and earn a GCSE in physics, but that exam doesn't cover anything I recognize as physics. Over the past year the UK Department for Education and the AQA board changed the subject. They took the physics out of physics and replaced it with... something else, something nebulous and ill defined.

I worry about this change. I worry about my pupils, I worry about the state of science education in this country, and I worry about the future physics teachers - if there will be any. I graduated from a prestigious university with a degree in physics and pursued a lucrative career in economics which I eventually abandoned to teach. Economics and business, though vastly easier than my subject, and more financially rewarding, bored me. I went into teaching to return to the world of science and to, in what extent I could, convey to pupils why one would love a subject so difficult.

For a time I did. For a time, I was happy. But this past academic year things changed. The Department for Education and the AQA board brought in a new syllabus for the sciences. One which greatly increased the teaching of `how science works.' While my colleagues expressed scepticism, I was hopeful. After all, most pupils will not follow science at a higher level, so we should at least impart them with a sense of what it can tell us about our universe. That did not happen. The result is a fiasco that will destroy physics in England.

The thing that attracts pupils to physics is its precision. Here, at last, is a discipline that gives real answers that apply to the physical world. But that precision is now gone. Calculations - the very soul of physics - are absent from the new GCSE. Physics is a subject unpolluted by a torrent of malleable words, but now everything must be described in words.

In this course, pupils debate topics like global warming and nuclear power. Debate drives science, but pupils do not learn meaningful information about the topics they debate. Scientific argument is based on quantifiable evidence. The person with the better evidence, not the better rhetoric or talking points, wins. But my pupils now discuss the benefits and drawbacks of nuclear power plants, without any real understanding of how they work or what radiation is.

I want to teach my subject, to pass on my love of physics to those few who would appreciate it. But I can't. There is nothing to love in the new course. I see no reason that anyone taking this new GCSE would want to pursue the subject. This is the death of physics.

George Monbiot, the environmental campaigner, scourge of the automobile industry and champion of not owning cars, has finally bought himself . . . a car. Notwithstanding pledges to live a green lifestyle and be a model to others, he has given in to temptation and acquired a secondhand Renault.

The car industry will be silently celebrating the news. Monbiot has championed an anticar movement that has grown rapidly in influence to the point where many owners now feel guilty about using their cars. His most recent book Heat: How to Stop the Planet Burning was a bestseller on both sides of the Atlantic. He once described the pro-car lobby as "antisocial bastards" and has blamed cars for ruining children's lives. "Our children are growing upsocially stunted: instead of playing together they are playing alone on their computers, partly because the streets are both dangerous and choked with cars."

In what can only be described as a comprehensive U-turn, Monbiot has chosen a Renault Clio, an economical hatchback but not the most frugal in fuel consumption or carbon emissions. He bought it from a friend for an undisclosed amount. As zealots will be quick to remind him, it emits 115g/km , 10% higher than a Toyota Prius, the petrol-electric hybrid belovedof CO2 of the green movement.

Jeremy Clarkson, Monbiot's long-standing antagonist, said: "I'm glad he hasn't gone for a Prius - that would have marked him out as an idiot. I just hope the bonnet doesn't fly up [Renault Clios have been criticised for faulty bonnet catches] because he'll be killed - then where would the world be?"

Monbiot says the Clio is the first car he has owned since he sold a Ford Escort in 1989. His move from Oxford to rural Wales with his family in January meant a change of lifestyle, and he discovered he needed personal transport. "I had cars from 1982 to 1989, then I didn't have a car until about six weeks ago," he says. "I've had to break a long-time commitment, but the only way to get by, we decided, was to have the occasional use of a car."

For ordinary motorists struggling with their consciences, Monbiot's decision will come as no surprise and will prompt the obvious question: if one of the country's highest-profile green campaigners can't manage without a car, how can the average commuter? Monbiot admits he is open to charges of hypocrisy but says people he has so far confessed to have been understanding. "I still feel pretty awful about it," he admits. "The rule is, if it's at all possible to travel by any other means, then that's what we do. The car is a last resort and I haven't even used a tank of petrol yet." (The Clio is in fact a diesel.)

THE government's policy of promoting biofuels for transport will come under harsh attack this week from one of its senior science advisers. Roland Clift will tell a seminar of the Royal Academy of Engineering that the plan to promote bioethanol and biodiesel produced from plants is a "scam".

Clift, professor of environmental technology at Surrey University, sits on the scientific advisory council of Defra, David Miliband's environment department. He will tell the seminar that promoting the use of biofuels is likely to increase greenhouse gas emissions. Clift's comments will amount to a direct challenge to Miliband, who has published a strategy promoting biofuels.

It coincides with a surge of anger among environmentalists over the weak pledges on climate change that emerged from last week's G8 summit. The audience on Thursday will also include Howard Dalton, Miliband's chief scientist at Defra, who is expected to speak in defence of biofuels.

Clift said: "Biodiesel is a complete scam because in the tropics the growing demand is causing forests to be burnt to make way for palm oil and similar crops. "We calculate that the land will need to grow biodiesel crops for 70-300 years to compensate for the CO2 emitted in forest destruction."

Clift will also condemn plans to produce British biodiesel from rapeseed, pointing to research showing the crop generates copious amounts of nitrous oxide - an even more powerful global warming gas than CO2

The attack comes as the government increases its support for biofuels. Next year it will introduce a requirement for 3% of all fuel sold on UK forecourts to come from a renewable source. Across the EU the renewable transport fuels obligation will increase this to 5% by 2010, with the British government pushing for a target of 10%. Miliband wants British farming to diversify into biofuels. "It is an important part of our vision for a diversified farming sector," he said in a recent speech.

Refreshing to see an epidemiological study that did NOT leap to the apparent conclusion. Even epidemiologists can think sometimes

Wealthier people are more than twice as likely to develop the deadliest form of skin cancer, research suggests. A study of more than 23,000 patients in Northern Ireland has shown a 20 per cent rise in patients suffering from skin cancer over a 12-year period. The research, published today in the British Journal of Dermatology, showed that women living in richer areas were 29 per cent more likely than people living in disadvantaged areas to suffer from basal cell carcinoma, and 2« times more likely to suffer from malignant melanoma, the most dangerous form of the disease. Men were 41 per cent more likely to suffer from basal cell carcinoma if they lived in an affluent area and 2« times more likely to suffer from malignant melanoma.

Every year there are estimated to be more than 100,000 cases of the more easily treated skin cancers in the UK, and just over 8,000 cases of malignant melanoma. The scientists, from the Royal Group of Hospitals and Queen's University Belfast, said that two explanations were most likely - that middle-class people took more holidays in sunny places, or were simply more likely to go for treatment when they developed suspicious-looking damage to their skin. Olivia Dolan, a co-author of the study and consultant dermatologist at the Royal Victoria Hospital, Belfast, said: "It's probably a combination of the two." Older people now developing skin cancers tend to be those from families who were rich enough to holiday overseas when they were young, when the skin is most vulnerable to such damage.

Analysis of the data, which came from the Northern Ireland Cancer Registry at Queen's University Belfast and covered the period from 1993 to 2004, indicated a 20 per cent increase in patients and a 62 per cent increase in skin cancer samples processed by pathology laboratories. Affluence did not seem to affect squamous cell carcinoma. This may be because numbers of this cancer were small, Dr Dolan said. She added that the results showed that skin cancer incidence was systematically underestimated, because only the first instance was recorded and many patients developed multiple cancers. "It would be very helpful if every cancer were recorded," she said.

Britain: Another loony down: "A woman wielding a handgun in a rural town centre yesterday became the first female to be deliberately shot dead by British police. The woman, whose silver pistol was later found to be a BB airgun, died from a single shot to the chest in a car park in the centre of Sevenoaks, Kent, after she refused to put down her weapon. Armed police were called after the 37-year-old woman, who was white and lived locally, was seen in the High Street brandishing her gun at about 1.20am yesterday. Officers from the police district headquarters in Tonbridge arrived about 10 minutes later but were unable to locate the woman until about 3am, when she was discovered in a car park close to the town's police station. "The woman was known to the police and was from the Sevenoaks area," said a police source. "She was waving a silver handgun around just before she was shot. "She was ordered to put the gun down, but she refused and an officer opened fire. The weapon recovered from the scene turned out to be a ball bearing gun. It looked realistic and that is why the officers had to take direct action."

Rather encouraging to see in a British Leftist periodical a relatively balanced evaluation of Communism. He points out however that Britain's major Leftist organ is still Stalinist ("revisionist"). The comment thread attached is interesting too.

Tony Blair gets this one right: "He said that newspapers no longer respected the division between reporting and comment, surprising many in the audience by singling out The Independent, the left-of-centre newspaper highly critical of Mr Blair over Iraq, as a metaphor for modern journalism. "[ The Independent] started as an antidote to the idea of journalism as views not news. That was why it was called The Independent. Today it is avowedly a viewspaper not merely a newspaper."

Postings from Brisbane, Australia by John Ray (M.A.; Ph.D.) -- former member of the Australia-Soviet Friendship Society, former anarcho-capitalist and former member of the British Conservative party.

Some TERMINOLOGY for non-British readers: The British "A Level" exam is roughly equivalent to a U.S. High School diploma. Rather confusingly, you can get As, Bs or Cs in your "A Level" results. Entrance to the better universities normally requires several As in your "A Levels".

Again for American readers: A "pensioner" is a retired person living on Social Security

Consensus. Margaret Thatcher in a 1981 speech: "For me, pragmatism is not enough. Nor is that fashionable word "consensus."... To me consensus seems to be the process of abandoning all beliefs, principles, values and policies in search of something in which no one believes, but to which no one objects—the process of avoiding the very issues that have to be solved, merely because you cannot get agreement on the way ahead. What great cause would have been fought and won under the banner "I stand for consensus"?

For my sins I have always loved G.B. Shaw's witty comment: "No Englishman can open his mouth without causing another Englishman to despise him". But Shaw was Irish, of course.

Britain has enormous claims to fame -- most of which the Labour goverment has been doing its best to destroy. But one glory no-one can destroy is British humour. And if you don't "get" British humour, your life is a dreary desert indeed. A superb sample here

Here is a link to my favourite British political speech since WWII. It is by Nigel Farage, the Leader of the UK Independence Party. He is referring to the Fascistic decision by the EU parliament to act as if their huge new "constitution" had been approved by the voters when in fact majorities in France, Ireland and Nederland (Holland) have rejected it at the ballot box. He points out that abuse is all they have to offer when he points out the impropriety of their actions.

Farage's expression, "A complete shower" is British slang meaning a group of completely incompetent and useless failures. It originated in the British armed forces where its unabbreviated version was "A complete shower of sh*t".

Britain appears to be the first country where anti-patriotism gained strong hold. Even Friedich Engels (the co-worker with Karl Marx who died in 1895) was a furious German patriot. Much of the British elite were anti-patriotic from the early 20th century onwards, however. The "Cambridge spies" (from one of Britain's two most prestigious universities) are a good example of that. Although Cambridge appears to have been the chief nest of spies-to-be in Britain of the 30s, however, Oxford was also very Leftist. In 1933 (9th Feb.) the Oxford Union debated the motion: "This House will in no circumstances fight for King and Country". The motion was overwhelmingly carried (275 to 153).

I have an abiding fascination with the Church of England. It is the sort of fascination one might have for a once-distinguished elderly relative who has gone bad and become a slave to the bottle. But nothing I can say about the C of E (which these days seems to stand for The Church of the Environment) could surpass what the whole of English literature says of it -- which ranges from seeing it as a collection of nincompoops and incompetents to seeing it as comprised of evil hypocrites. Yet its 39 "Articles of Religion" of 1562 are an abiding and eloquent statement of Protestant faith. But I guess that 1562 is a long time ago.

Links about antisemitism in 21st century Britain here and here and here

The intellectual Roman Emperor Marcus Aurelius (AD 121-180) could well have been thinking of modern Britain when he said: "The object in life is not to be on the side of the majority, but to escape finding oneself in the ranks of the insane."

On all my blogs, I express my view of what is important primarily by the readings that I select for posting. I do however on occasions add personal comments in italicized form at the beginning of an article.

I am rather pleased to report that I am a lifelong conservative. Out of intellectual curiosity, I did in my youth join organizations from right across the political spectrum so I am certainly not closed-minded and am very familiar with the full spectrum of political thinking. Nonetheless, I did not have to undergo the lurch from Left to Right that so many people undergo. At age 13 I used my pocket-money to subscribe to the "Reader's Digest" -- the main conservative organ available in small town Australia of the 1950s. I have learnt much since but am pleased and amused to note that history has since confirmed most of what I thought at that early age.

I imagine that the RD are still sending mailouts to my 1950s address

The kneejerk response of the Green/Left to people who challenge them is to say that the challenger is in the pay of "Big Oil", "Big Business", "Big Pharma", "Exxon-Mobil", "The Pioneer Fund" or some other entity that they see, in their childish way, as a boogeyman. So I think it might be useful for me to point out that I have NEVER received one cent from anybody by way of support for what I write. As a retired person, I live entirely on my own investments. I do not work for anybody and I am not beholden to anybody. And I have NO investments in oil companies, mining companies or "Big Pharma"

UPDATE: Despite my (statistical) aversion to mining stocks, I have recently bought a few shares in BHP -- the world's biggest miner, I gather. I run the grave risk of becoming a speaker of famous last words for saying this but I suspect that BHP is now so big as to be largely immune from the risks that plague most mining companies. I also know of no issue affecting BHP where my writings would have any relevance. The Left seem to have a visceral hatred of miners. I have never quite figured out why.

I am an army man. Although my service in the Australian army was chiefly noted for its un-notability, I DID join voluntarily in the Vietnam era, I DID reach the rank of Sergeant, and I DID volunteer for a posting in Vietnam. So I think I may be forgiven for saying something that most army men think but which most don't say because they think it is too obvious: The profession of arms is the noblest profession of all because it is the only profession where you offer to lay down your life in performing your duties. Our men fought so that people could say and think what they like but I myself always treat military men with great respect -- respect which in my view is simply their due.

Although I have been an atheist for all my adult life, I have no hesitation in saying that the single book which has influenced me most is the New Testament. And my Scripture blog will show that I know whereof I speak.

Many people hunger and thirst after righteousness. Some find it in the hatreds of the Left. Others find it in the love of Christ. I don't hunger and thirst after righteousness at all. I hunger and thirst after truth. How old-fashioned can you get?

My academic background

My full name is Dr. John Joseph RAY. I am a former university teacher aged 65 at the time of writing in 2009. I was born of Australian pioneer stock in 1943 at Innisfail in the State of Queensland in Australia. I trace my ancestry wholly to the British Isles. After an early education at Innisfail State Rural School and Cairns State High School, I taught myself for matriculation. I took my B.A. in Psychology from the University of Queensland in Brisbane. I then moved to Sydney (in New South Wales, Australia) and took my M.A. in psychology from the University of Sydney in 1969 and my Ph.D. from the School of Behavioural Sciences at Macquarie University in 1974. I first tutored in psychology at Macquarie University and then taught sociology at the University of NSW. My doctorate is in psychology but I taught mainly sociology in my 14 years as a university teacher. In High Schools I taught economics. I have taught in both traditional and "progressive" (low discipline) High Schools. Fuller biographical notes here

NOTE: The archives provided by blogspot below are rather inconvenient. They break each month up into small bits. If you want to scan whole months at a time, the backup archives will suit better. See here or here